Dr. Mark Ryan

Mark Ryan, MD, FAAFP, practices family medicine in Richmond, VA, teaches, volunteers, travels, and tweets! He is assistant clinical professor of family medicine for Virginia Commonwealth University, and medical director for the school's international/inner city/rural preceptorship. He works in three different practices. One is the faculty practice in downtown Richmond, where most of the patients re uninsured and receive care under the health system's patient assistance program. He also works in a satellite clinic in south Richmond seeing mostly pediatrics patients, 90% of whom are Spanish-speaking. He also teaches in a free clinic one evening a week, and spent four years working in rural private practice before joining the VCU faculty. Dr. Ryan is active on social media, tweeting from @RichmondDoc(twitter.com) and sharing opinions on WordPress(smhcop.wordpress.com), Tumblr(richmonddoc.tumblr.com), and Blogspot(www.richmonddoc.blogspot.com).

Q: What led you to practice family medicine?

Dr. Ryan: When I entered medical school I was considering pediatrics or family medicine. My decision to enter family medicine had two major influences. The first was a desire to wrok in rural Virginia, where I felt that the scope of practice of family medicine would make me more valuable to the community. The second was the influence of mentors who were family physicians. Two doctors in particular showed me the intellectual, personal, and community benefits of family medicine. I am proud to be working alongside them as colleagues today.

Q: What do you love about your work?

Dr. Ryan: I love the long-term, abiding connections that we can make with our patients. These connections are unfettered by the patients' genders, ages, or the nature of their complaints. I love that we help patients who present with undifferentiated complaints determine what might be happening, and then help patients make a decision as to the best approach to care. I love that I can see all members of a given family. I love that I have a chance to prevent, detect, or intervene upon illness before long-term complications develop. I love the academic challenges of figuring out how to address patients with complicated medical and phychosocial issues and the simple rewards of watching a healthy child grow and develop over time. The breadth of what I do, the nature of my role, the abiding relationships with patients are immensely gratifying.

Q: What is your most vivid memory from medical school?

Dr. Ryan: That seems so long ago.... I think it would be the first patient I took care of who was admitted to evaluate a non-specific complaint and was diagnosed with a terminal illness. Over the course of two weeks I worked with him and his family, I saw his condition change and his disase progress. He and his family had chosen to pursue comfort care, and they trusted us with his care instead of requesting he be moved to the palliative care unit. The role we played--discussing the goals of care with the patient and his family, ensuring that he was comfortable, and keeping in close contact--is one that I think demonstrates the core of any doctor/patient relationship. We cannot always fix or heal, but we can help and comfort, and we must do so within the parameters of what the patient feels is important.

Q: What surprised you most as a new physician?

Dr. Ryan: I may have had an easier transition into practice than many. I joined a practice one county west of where I trained, and my training in a rural residency program prepared me very well for working in a rural town of 900 people. The largest surprises were probably two-fold. The first was the amount and nature of administrative work that was required when one was seeing 20-25 patients every day, without time away from the office for elective rotations, etc. The second was the fact that difficult or challenging patients were my responsibility alone. There was no faculty to protect me, and, despite a supportive employer, I would need to figure problems out on my own. This was more of a challenge than the technical aspects of medicine.

Q: Describe a typical day for you.

Dr. Ryan: I don't have a typical day. Mondays I have time to work on administrative and teaching tasks, as well as other official obligations, as medical director for an underserved training track for medical students. Monday evening I am the primary medical attending at a teaching clinic where medical and pharmacy students see patients in teams as part of the medical students' introduction to clinical medicine. This clinic ends around 10 p.m., so I get Tuesday morning off. Tuesday afternoon and all day Friday I work in south Richmond seeing all pediatric patients, most of whom are Spanish-speaking. Wednesday and Thursday mornings are spent working, teaching and administrative tasks, while the afternoons are spent at the faculty practice. I try not to schedule anything work-related on the weekends, but we occasionally have community outreach events that take some time. I am trying very hard not to bring work home, though I don't do as well with this as I should.

Q: How have things changed since you entered the field?

Dr. Ryan: When I completed medical school in 2000, our health care system was working its way through the impact of managed care. While in practice, I was regularly surprised at the advances in medicine that made what I learned in medical school outdated. However, the largest trends I have noted recently are the (likely connected) facts that our health care system has continued to get more and more expensive without commensurate improvement in health outcomes, and that the issue of uninsured Americans has become a larger and larger concern even as attempts to address the problem finally got underway.

Q: What has been the greatest challenge you have faced as a family physician?

Dr. Ryan: The greatest challenge I have faced is that of enhancing medical care and patient health in a system that is a health care system in name only. I have worked in too many underserved communities and with too many uninsured patients in too many safety net clinics to believe that our system is working. It isn't — it's just barely getting by. We spend too much money on care that doesn't lead to commensurate benefits, and we leave far too many people behind. This is a greater challenge than figuring out a single patient's clinical care — how to address and reform a system that is very good at producing the fragmented and inefficient care we currently provide. Physicians can address this by becoming involved in efforts to reform the system to push it to take better care of people.

Q: What do you tell undecided medical students who are considering family medicine?

Dr. Ryan: I usually highlight the variety of what family physicians can do, the central roles we play in our patients' lives and in a good health care system, and the manifold skills we are called on to use to do our jobs and to answer to our vocation. I couldn't think of anything better.

Q: What advice would you give your medical student self?

Dr. Ryan: I would advise myself to learn to balance work and home life a bit better. I still struggle with this, and perhaps a better system developed when I was younger would have helped me find this elusive balance more easily.

Q: How are you involved in community service and what motivates you to do this kind of work?

Dr. Ryan: I am involved in a number of community service activities. I am president of the board of directors for two non-profit organizations, Hombre Medicine(hombremedicine.org) and Dominican Aid Society of Virginia(dominicanaidsociety.com), that provide health care for underserved communities overseas. I am on the board of a third organization, W&M Student Organization for Medical Outreach and Sustainability. I am incoming vice president for communications for the National Physicians Alliance(npalliance.org), a multi-specialty medical organization that focuses on issues of patient access to care, influence-free medical practice, etc., and I am the secretary of the Virginia Academy of Family Physicians. Finally, I am one of the founders and the medical director for a project named "Una Vida Sana!". This is a multi-disciplinary service-learning project in which students from VCU's schools of medicine, nursing, and pharmacy work together to provide cardio-metabolic disease screenings to the Hispanic community in Richmond. We usually partner with established community events, and refer patients in need to definitive care to a local free clinic. The reason I do all these things is because I think medicine is much more than a job; it is a vocation, a calling, and its obligations extend beyond the office. I do not think it is sufficient to do a hard day's work, and then go home and rest for the next day. Our patients' health is affected far more by what goes on outside the office than what happens inside. Social determinants of health, insurance, etc., all have major impacts on health physicians' need to advocate on behalf of our patients' and communities' health in order to help keep people well and ensure the best outcomes we can. This is one reason why I am active on social media; I feel that I should bring my experience and expertise to bear on discussions that I think affect the health of individuals and communities. To me, this is part of the expectation communities should have of their physicians. Whether advocating for or against specific policies, working to provide outreach to marginalized communities, or helping a non-profit further its mission, I feel this is the complete picture of what a physician's obligations are.